关节镜下肩胛下肌腱修复联合喙突成形术治疗肩胛下肌腱损伤的疗效分析  

Therapeutic efficacy of arthroscopic repair of subscapularis tendon combined with coracoplasty in treating subscapularis tendon injuries

作　　者：郑翰林 刘雨龙 陈光 宁仁德 刘明祥 江华 房传武 ZHENG Hanlin;LIU Yulong;CHEN Guang;NING Rende;LIU Mingxiang;JIANG Hua;FANG Chuanwu(Department of Orthopedics,the Third Affiliated Hospital of Anhui Medical University(Hefei First People’s Hospital),Hefei,Anhui 230032,China)

机构地区：[1]安徽医科大学第三附属医院(合肥市第一人民医院)关节外科,安徽230032

出　　处：《中国骨与关节损伤杂志》2024年第7期707-711,共5页Chinese Journal of Bone and Joint Injury

基　　金：安徽省重点研究与开发计划项目(202104j07020057);合肥市卫生健康应用项目(Hwk2021yb003)。

摘　　要：目的比较关节镜下肩胛下肌腱修复联合喙突成形术与单纯肩胛下肌腱修复术治疗因喙突撞击导致肩胛下肌腱损伤的临床疗效。方法回顾性分析自2020-01—2023-01采用肩关节镜手术治疗的30例因喙突撞击导致的肩胛下肌腱损伤,其中15例(A组)采用肩胛下肌腱修复联合喙突成形术治疗,15例(B组)单纯行肩胛下肌腱修复术治疗而喙突不作处理。比较组间术后6个月疼痛VAS评分、患肩体侧主动外旋活动度、喙肱距离、肩关节功能UCLA评分、肩关节功能ASES评分。结果30例均获得随访,随访时间6~12个月,平均8.7个月。术后切口均一期愈合,未发生全身或肩关节局部感染、臂丛神经损伤等并发症。A组随访期内未发生肩胛下肌腱再撕裂的情况,而B组1例术后10个月肩胛下肌腱再撕裂。A组术后6个月疼痛VAS评分、患肩体侧主动外旋活动度、喙肱距离、肩关节功能UCLA评分、肩关节功能ASES评分优于B组,差异有统计学意义(P<0.05)。结论喙突撞击是导致肩胛下肌腱损伤的重要原因,此类患者采用关节镜下肩胛下肌腱修复联合喙突成形术治疗的效果优于单纯肩胛下肌腱修复术。Objective To compare the clinical efficacy of arthroscopic subscapular tendon repair combined with coracoplasty formation versus simple subscapular tendon repair for the treatment of subscapular tendon injuries caused by subcoracoid impingement syndrome.Methods A retrospective analysis was conducted on 30 cases of subscapularis tendon injury due to subcoracoid impingement treated with arthroscopic surgery from January 2020 to January 2023.Among these,15 cases(group A)underwent subscapularis tendon repair combined with coracoplasty,while the remaining 15 cases(group B)only received subscapularis tendon repair without any treatment on the coracoid.Two groups were compared at 6 months after operation in terms of pain VAS scores,active external rotation range of motion of the affected shoulder,coracohumeral distance,shoulder function UCLA score,and shoulder function ASES score.Results All 30 cases were followed up for 6 to 12 months,with an average of 8.7 months.Postoperative incisions all healed in one stage,without complications such as systemic or local shoulder joint infections and brachial plexus nerve damage.No re-tearing of the subscapular tendon occurred in group A during the follow-up period,while one case in group B experienced re-tearing of the subscapular tendon at 10 months postoperatively.At 6 months postoperatively,the pain VAS scores,active external rotation range of motion of the affected shoulder,coracoid-humeral distance,shoulder joint function UCLA scores,and shoulder joint function ASES scores in group A were better than those in group B,with statistically significant differences(P<0.05).Conclusion Subcoracoid impingement syndrome is a significant cause of subscapular tendon injury.The outcome of treating such patients with arthroscopic subscapular tendon repair combined with coracoplasty is superior to that of simple subscapular tendon repair.

关 键 词：肩胛下肌腱损伤 喙突下撞击征 关节镜 喙突成形 喙肱距离 

分 类 号：R686.1[医药卫生—骨科学]